Fitting SGLT2 Inhibitors in Diabetes Care

This is yet another doctor that believes diabetes is progressive and talks about it in that way. He does not acknowledge that the progression can be halted, but that the complications can be mitigated to some degree with the right medication. How deflating this must be for his patients.

He is talking about SGLT2 and how this medication is needed to lessen to severity of the complications. He states, “We need different treatments and different combinations of treatments to focus on these different factors at different times as the disease progresses.”

Clifford J. Bailey, PhD, Professor of Clinical Science at Aston University in Birmingham, United Kingdom says, “We now have very good evidence that good glycemic control, especially at the very beginning of type 2 diabetes, after diagnosis, is also very important in the long term to reduce the onset and severity of the complications of type 2 diabetes and to reduce macrovascular risk. Therefore, there is very good rationale for using as many therapies as we need at different times to control hyperglycemia.”

Now, if he would just read what he said, he might just realize that the onset of complications can be managed and diabetes can be non-progressive. Here again, I would be inclined to believe that this doctor is not big on diabetes education and lets his patients wallow in ignorance; therefore insuring that he has patients to treat for the complications.

At least we can know that he has conflicts of interest in his promotion of SGLT2 medications. Disclosure: Clifford J. Bailey, PhD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Abbott Cardiovascular Systems, Inc. (formerly Advanced Cardiovascular Systems, Inc.) ; AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Company; Boehringer Ingelheim; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Eli Lilly and Company; Merck Sharp Dohme; Novo Nordisk; Takeda Pharmaceuticals North America, Inc.; sanofi-aventis

Serve(d) as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Company; Boehringer Ingelheim; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Eli Lilly and Company; Merck Sharp Dohme; Novo Nordisk; sanofi-aventis

Received research grant from: AstraZeneca Pharmaceuticals LP; sanofi-aventis

At least he does list the problem areas for the class SGLT2 medications, but even then he couches it very carefully by promoting the drug while listing the urinary track infections and stating that the patients need adequate renal function before taking the drug. He does state the following - “Chronic kidney disease is an issue in advancing years in patients with type 2 diabetes, and so that is one of the precautions that needs to be seriously considered when choosing to use this type of therapy. That said, because this type of therapy is non-insulin dependent, it can be used early in the progression of type 2 diabetes as an add-on to the monotherapies that we have available at the moment.”

I would be very cautious if renal function may be impaired and I would demand to be tested for this before allowing this medication to be prescribed to me. This is a subject that needs to be raised with your doctor.